Dexamethasone - instructions for use, dose, side effects, contraindications

Active substance:
Dexamethasone	- 0.0005 g
Auxiliary substancesva:	to obtain a tablet weighing 0.15 g
potato starch	- 0.0340 g
sucrose (sugar)	- 0.1140 g
stearic acid	- 0.0015 g

Description:

Tablets of white color, flat-cylindrical, with a facet.

Pharmacotherapeutic group:Glucocorticosteroid

ATX: & nbsp

H.02.A.B.02 Dexamethasone

S.01.B.A.01 Dexamethasone

H.02.A.B Glucocorticoids

S.01.B.A Corticosteroids

Pharmacodynamics:

Dexamethasone is a synthetic glucocorticosteroid (GCS), methylated derivative of fluoride prednisolone. Has anti-inflammatory, antiallergic, desensitizing, immunosuppressive, anti-shock and antitoxic action.

Oppressing the secretion of thyroid-stimulating hormone and follicle-stimulating hormone. Increases the excitability of the central nervous system, reduces the number of lymphocytes and eosinophils, increases the number of erythrocytes (stimulates the production of erythropoietins).

Interacts with specific cytoplasmic receptors and forms a complex penetrating into the nucleus of the cell, stimulates the synthesis of matrix ribonucleic acid (mRNA); the latter induces the formation of proteins, including lipocortin, that mediate cellular effects. Lipocortin depresses phospholipase A2, inhibits the release of arachidonic acid, and suppresses the synthesis of endoperoxides, prostaglandins, leukotrienes, which promote inflammation, allergies, and others.

Influence on protein metabolism: reduces the amount of protein in the plasma (due to globulins) with an increase in the albumin / globulin ratio, increases the synthesis of albumins in the liver and kidneys; enhances protein catabolism in muscle tissue.

Effect on lipid metabolism: increases the synthesis of higher fatty acids and triglycerides, redistributes fat (accumulation of fat mainly in the area of the shoulder girdle, face, abdomen), leads to the development of hypercholesterolemia.

Influence on carbohydrate metabolism: increases the absorption of carbohydrates from the gastrointestinal tract (GIT); increases the activity of glucose-6-phosphatase, leading to an increase in the intake of glucose from the liver into the blood; increases the activity of phosphoenolpyruvate carboxylase and the synthesis of aminotransferases, which leads to activation of gluconeogenesis.

Influence on water-electrolyte exchange: detains sodium ions and water in the body, stimulates the excretion of potassium ions (mineralocorticosteroid activity), reduces the absorption of calcium ions from the digestive tract, "removes" calcium ions from the bones, increases the excretion of calcium ions by the kidneys.

Anti-inflammatory action is associated with the inhibition of eosinophil release by inflammatory mediators; inducing the formation of lipocortins and reducing the number of mast cells that produce hyaluronic acid; with a decrease in the permeability of capillaries; stabilization of cell membranes and membranes of organelles (especially lysosomal).

Antiallergic effect develops as a result of suppression of synthesis and secretion of mediators of allergy, inhibition of release from sensitized mast cells and basophils of histamine and other biologically active substances, and a decrease in the number of circulating basophils. inhibition of lymphoid and connective tissue development, decrease in the number of T - and B - lymphocytes, mast cells, reducing the sensitivity of effector cells to mediators of allergy. oppression of antibody formation, changes in the immune response of the body.

In chronic obstructive pulmonary disease, the action is mainly based on inhibition of inflammatory processes, inhibition of development or prevention of edema of the mucous membranes, inhibition of eosinophilic infiltration of the submucosal layer of bronchial epithelium, deposition of circulating immune complexes in the mucosa of the bronchi, and inhibition of erosion and desquamation of the mucosa.

Increases the sensitivity of beta-adrenergic receptors of bronchi of small and medium caliber to endogenous catecholamines and exogenous sympathomimetics, reduces the viscosity of bronchial secretions due to oppression or reduction of its production.

Anti-shock and antitoxic action is associated with an increase in blood pressure (by increasing the concentration of circulating catecholamines and restoring the sensitivity of adrenoreceptors to them, as well as vasoconstriction), a decrease in the permeability of the vascular wall, membrane-protective properties, activation of liver enzymes involved in the metabolism of endo- and xenobiotics.

Immunosuppressive action is caused by inhibition of the release of cytokines (interleukin-1, interleukin-2, interferon gamma) from lymphocytes and macrophages.Suppresses the synthesis and secretion of adrenocorticotropic hormone (ACTH), and again - the synthesis of endogenous GCS.

The peculiarity of the action is a significant inhibition of the pituitary function and a virtually complete absence of mineralocorticosteroid activity. Doses of 1-1.5 mg / day inhibit the adrenal cortex; the biological half-life is 32-72 hours (the duration of oppression of the hypothalamus-pituitary-cortical adrenal gland system).

The strength of the glucocorticoid activity of 0.5 mg of dexamethasone corresponds to approximately 3.5 mg of prednisolone, 15 mg of hydrocortisone or 17.5 mg of cortisone for oral dosage forms.

Pharmacokinetics:

Absorption

After oral intake quickly and completely absorbed, the maximum concentration of dexamethasone in blood plasma - 1-2 hours.

Distribution

Blood is bound (60-70%) with a specific transporter protein - transcortin. Easily passes through gistogematicheskie barriers (including through blood-brain and placental barriers).

Metabolism

Metabolised in the liver (mainly by conjugation with glucuronic and sulfuric acids) to inactive metabolites.

Excretion

It is excreted by the kidneys (a small amount of dexamethasone penetrates into the breast milk). Half-life is 3-5 hours.

Indications:

Systemic diseases of connective tissue (systemic lupus erythematosus, scleroderma, nodular periarteritis, dermatomyositis, rheumatoid arthritis).

Acute and chronic inflammatory diseases of the joints: gouty and psoriatic arthritis, osteoarthritis (including posttraumatic), polyarthritis, humeropathy periarthritis, ankylosing spondylitis (Bechterew's disease), juvenile arthritis, Still's syndrome in adults, bursitis, nonspecific tenosynovitis, synovitis and epicondylitis.

Rheumatic fever, acute rheumatic heart disease.

Acute and chronic allergic diseases: allergic reactions to medicines and food products, serum sickness, urticaria, allergic rhinitis, angioedema, drug exanthema, pollinosis.

Skin diseases: pemphigus, psoriasis, eczema, atopic dermatitis, diffuse neurodermatitis, contact dermatitis (with the defeat of a large surface of the skin), toxicermy, seborrheic dermatitis, exfoliative dermatitis,toxic epidermal necrolysis (Lyell's syndrome), bullous herpetiform dermatitis, malignant exudative erythema (Stevens-Johnson syndrome).

Cerebral edema (only after confirming the symptoms of increased intracranial pressure by magnetic resonance or computed tomography) caused by a brain tumor and / or associated with surgery or radiation damage.

Allergic eye diseases: allergic corneal ulcers, allergic forms of conjunctivitis.

Inflammatory eye diseases: sympathetic ophthalmia, severe sluggish anterior and posterior uveitis, optic neuritis.

Primary or secondary adrenal insufficiency (including the condition after removal of the adrenal glands).

Congenital hyperplasia of the adrenal glands.

Kidney disease of autoimmune genesis (including acute glomerulonephritis); nephrotic syndrome.

Subacute thyroiditis.

Diseases of the hematopoiesis - agranulocytosis, panmyelopathy, autoimmune hemolytic anemia, acute lympho- and myeloid leukemia, lymphogranulomatosis, thrombocytopenic purpura, secondary thrombocytopenia in adults,erythroblastopenia (erythrocyte anemia), congenital (erythroid) hypoplastic anemia.

Lung diseases: acute alveolitis, pulmonary fibrosis, sarcoidosis II-III stage.

Bronchial asthma (with bronchial asthma, the drug is prescribed only in severe cases, ineffectiveness or inability to take inhaled glucocorticosteroids).

Tuberculous meningitis, pulmonary tuberculosis, aspiration pneumonia (in combination with specific chemotherapy).

Berylliosis, Leffler's syndrome (not amenable to other therapy).

Lung cancer (in combination with cytostatics).

Multiple sclerosis.

Diseases of the gastrointestinal tract: ulcerative colitis, Crohn's disease, local enteritis.

Hepatitis.

Prevention of graft rejection as part of complex therapy.

Hypercalcemia on the background of cancer, nausea and vomiting during cytostatic therapy.

Myeloma disease.

Conduct a sample in the differential diagnosis of hyperplasia (hyperfunction) and adrenal cortex tumors.

Contraindications:

For short-term use according to "vital" indications, the only contraindication is hypersensitivity; systemic mycosis; simultaneous application of live and weakened vaccines with immunosuppressive doses of the drug; intolerance to sucrose,deficiency of isomaltase / sucrose, glucose-galactose malabsorption; the period of breastfeeding; children's age up to 3 years.

Carefully:

Parasitic and infectious diseases of viral, fungal or bacterial origin (currently or recently transferred, including the recent contact with the patient) - herpes simplex, herpes zoster (viremicheskaya phase), chicken pox, measles; amoebiasis, strongyloidiasis (or suspected); active and latent tuberculosis. Application in severe infectious diseases is permissible only against the background of specific antimicrobial therapy.

Pre- and post-vaccination period (8 weeks before and 2 weeks after vaccination), lymphadenitis after BCG vaccination.

Immunodeficiency conditions (including acquired immunodeficiency syndrome or human immunodeficiency virus (HIV infection)).

Diseases of the gastrointestinal tract: peptic ulcer of stomach and duodenum, esophagitis, gastritis, acute or latent peptic ulcer, newly created intestinal anastomosis, ulcerative colitis with perforation or abscessing, diverticulitis.

Diseases of the cardiovascular system,including recent myocardial infarction (in patients with acute and subacute myocardial infarction may spread necrosis, slowing the formation of scar tissue, and as a consequence - the gap of the heart muscle), decompensated chronic heart failure (CHF), hypertension, hyperlipidemia.

Endocrine diseases - diabetes (including impaired tolerance to carbohydrates), thyrotoxicosis, hypothyroidism, Itenko-Cushing's disease, obesity (III-IV stage).

Severe chronic renal and / or hepatic insufficiency, nephrourolythiasis.

Hypoalbuminemia and conditions predisposing to its occurrence.

Systemic osteoporosis, myasthenia gravis gravis, acute psychosis, poliomyelitis (except for the form of bulbar encephalitis), open and closed angle glaucoma.

The use of the drug in elderly patients (due to the high risk of osteoporosis and hypertension).

Acute psychosis, severe affective disorders (including in history).

Eye infection caused by the herpes simplex virus (due to the risk of corneal perforation).

During pregnancy.

In children during the growth period, SCS should be used only in absolute indications and under the strictest supervision of the attending physician.

Pregnancy and lactation:

Dexamethasone penetrates the placenta (it can reach high concentrations in the fetus) and into breast milk. During pregnancy, especially in the first trimester, or in women planning pregnancy, the use of the drug Dexamethasone It is only indicated if the expected curative effect exceeds the risk of a negative effect on the mother or fetus. SCS should be administered during pregnancy only on absolute indications. With prolonged therapy during pregnancy, the possibility of fetal dysfunction is not ruled out. In the case of use in the III trimester of pregnancy, there is a risk of atrophy of the adrenal cortex in the fetus, which may require replacement therapy in the newborn.

If it is necessary to carry out treatment with the drug during breastfeeding, then breastfeeding should be discontinued.

Dosing and Administration:

Inside, in individually selected doses, the magnitude of which is determined by the type of disease, the degree of its activity and the nature of the patient's response.

The average daily dose is 0.75-9 mg.In severe cases, large doses divided into 3-4 doses may be used. The maximum daily dose is usually 15 mg. After reaching the therapeutic effect, the dose is gradually reduced (usually by 0.5 mg in 3 days) to the maintenance dose - 2-4.5 mg / day. The minimum effective dose is 0.5-1 mg / day. Children (depending on age) are prescribed 83.3-333.3 mcg / kg or 2.5-10 mg / m 2 / day in 3-4 doses.

The duration of dexamethasone depends on the nature of the pathological process and the effectiveness of treatment and ranges from several days to several months or more. Treatment is stopped gradually (at the end, several injections of corticotropin are prescribed).

With bronchial asthma, rheumatoid arthritis, ulcerative colitis - 1,5-3 mg / day; with systemic lupus erythematosus - 2-4,5 mg / day; with oncohematological diseases - 7.5-10 mg.

For the treatment of acute allergic diseases it is advisable to combine parenteral and oral administration: 1 day - 4-8 mg parenterally; 2 day - inside, 4 mg 3 times a day; 3, 4 day - inside, 4 mg 2 times a day; 5, 6 day - 4 mg / day, inside; Day 7 - cancellation of the drug.

A trial with dexamethasone (Liddell test). It is conducted in the form of small and large tests. With a small test dexamethasone give the patient a dose of 0.5 mg every 6 hours during the day (ie at 8 am, at 2 pm and 2 am). Urine to determine 17-oxycorgicosteroid or free cortisol is collected from 8 am to 8 am 2 days before the appointment of dexamethasone and also 2 days at the same time intervals after taking these doses of dexamethasone. These doses of dexamethasone inhibit the formation of corticosteroids in almost all practically healthy individuals. Six hours after the last dose of dexamethasone, the cortisol content in the plasma is lower than 135-138 nmol / L (less than 4.5-5 μg / 100 ml). Reducing the excretion of 17-hydroxycorticosteroids below 3 mg / day, and free cortisol below 54-55 nmol / day (below 19-20 μg / day) excludes hyperfunction of the adrenal cortex. At faces. suffering from Disease or Cushing's syndrome, there is no change in the secretion of corticosteroids during a small test.

When carrying out a large test dexamethasone prescribe 2 mg every 6 hours for 2 days (that is, 8 mg of dexamethasone per day). Urine is also collected to determine 17-oxycorticosteroids or free cortisol (if necessary, determine free cortisol in the plasma).With Isenko-Cushing's disease, there is a decrease in excretion of 17-hydroxycorticosteroids or free cortisol by 50% or more, while adrenal gland tumors or adrenocorticotropic-ectopic (or corticoliberin-ectopic) syndrome do not change the excretion of corticosteroids. In some patients with adrenocorticotropic-ectopic reduction syndrome, corticosteroids are not detected even after taking dexamethasone at a dose of 32 mg / day.

Side effects:

The frequency of development and severity of side effects depend on the duration of application, the amount of dose used and the possibility of observing the circadian rhythm of the appointment. Usually dexamethasone well tolerated. It has a low mineralocorticoid activity, that is, its effect on water-electrolyte metabolism is small. As a rule, low and medium doses of dexamethasone do not cause delays in sodium and water in the body, increased excretion of potassium.

The following side effects are described:

Disorders from the endocrine system: a decrease in glucose tolerance, "steroid" diabetes mellitus or the manifestation of latent diabetes mellitus,suppression of adrenal function, Itzenko-Cushing syndrome (lunar face, obesity of the pituitary type, hirsutism, increased blood pressure, dysmenorrhea, amenorrhea, myasthenia gravis, striae), delay in sexual development in children.

Violations of the blood and lymphatic system: moderate leukocytosis, leukocyturia, lymphopenia, eosinopenia, polycythemia.

Disorders from the gastrointestinal tract: nausea, vomiting, abdominal pain, discomfort in the epigastric region, pancreatitis, steroid ulcer of the stomach and duodenum, erosive esophagitis, bleeding and perforation of the wall of the stomach and intestines, increase or decrease in appetite, flatulence, hiccough. In rare cases - increased activity of "liver" transaminases and alkaline phosphatase.

Violations from the heart and blood vessels: arrhythmias, bradycardia (up to cardiac arrest); development (in predisposed patients) or progression of CHF, electrocardiographic changes characteristic of hypokalemia, increased blood pressure, hypercoagulation, thrombosis and thromboembolism, vasculitis, increased fragility of capillaries.In patients with acute and subacute myocardial infarction - the spread of the focus of necrosis, slowing the formation of scar tissue, which can lead to rupture of the heart muscle.

Disturbances from the nervous system: increased intracranial pressure, pseudotumor of the cerebellum, headache, convulsions.

Disorders from the psyche: nervousness or anxiety, insomnia, emotional lability, delirium, disorientation, euphoria, hallucinations, manic-depressive psychosis, depression, paranoia, suicidal tendencies.

Violations from the side of the organ of vision: posterior subcapsular cataract, increased intraocular pressure with possible damage to the optic nerve, propensity to develop secondary bacterial, fungal or viral eye infections, trophic corneal changes, exophthalmos, corneal perforation, central serous chorioretinopathy.

Hearing disorders and labyrinthine disorders: dizziness, vertigo.

Disorders from the metabolism and nutrition: hypercholesterolemia, increased excretion of calcium ions, hypocalcemia, weight gain, negative nitrogen balance (increased protein breakdown), increased sweating, epidural lipomatosis.

Caused by mineralocorticosteroid activity - fluid retention and sodium ions (peripheral edema), hypernatremia, hypokalemic syndrome (hypokalemia, arrhythmia, myalgia or muscle spasm, unusual weakness and fatigue).

Disturbances from musculoskeletal and connective tissue: slowing the growth and processes of ossification in children (premature closure of epiphyseal growth zones), osteoporosis (very rarely - pathological bone fractures, aseptic necrosis of the head of the humerus and thigh bone), rupture of muscle tendons, steroid myopathy, muscle loss (atrophy).

Disturbances from the skin and subcutaneous tissues: delayed healing of wounds, petechiae, ecchymosis, thinning of the skin, atrophy of the skin and subcutaneous tissue, hyper- or hypopigmentation, "steroid" acne, striae, propensity to develop pyoderma and candidiasis, skin pigmentation (hypo- or hyperpigmentation), telangiectasia.

Immune system disorders: generalized (skin rash, skin itching, anaphylactic shock), local allergic reactions.

Infectious and parasitic diseases: development or exacerbation of infections (the emergence of this side effect is facilitated by jointly used immunosuppressants and vaccination), masking infections.

General disorders and disorders at the site of administration: withdrawal syndrome.

Overdose:

It is possible to increase dose-dependent side effects, except for allergic reactions. It is necessary to reduce the dose of dexamethasone.

Treatment: symptomatic.

Interaction:

Dexamethasone increases the toxicity of cardiac glycosides (because of the resulting hypokalemia, the risk of arrhythmias increases).

Accelerates the removal of acetylsalicylic acid, reduces its concentration in the blood (with the abolition of dexamethasone, the concentration of salicylates in the blood increases and the risk of side effects increases).

With simultaneous use with live antiviral vaccines and against other types of immunizations, increases the risk of virus activation and the development of infections.

Increases the metabolism of isoniazid, mexiletine (especially in "fast acetylators"), which leads to a decrease in their plasma concentrations.

Increases the risk of hepatotoxic effects of paracetamol (induction of "hepatic" enzymes andformation of a toxic metabolite of paracetamol).

Increases (with prolonged therapy) the content of folic acid.

Hypokalemia caused by SCS can increase the severity and duration of muscle blockade against the background of muscle relaxants.

In high doses reduces the effect of somatropin.

Antacids reduce the absorption of GCS funds.

Dexamethasone reduces the effect of hypoglycemic drugs: enhances the anticoagulant effect of coumarin derivatives.

Weaken the influence of vitamin D on the absorption of calcium ions in the lumen of the intestine. Ergocalciferol and parathyroid hormone interfere with the development of osteopathy caused by SCS.

Reduces the concentration of praziquantel in the blood.

Cyclosporine (inhibits metabolism) and ketoconazole (reduces clearance) increase toxicity.

Thiazide diuretics, carbonic anhydrase inhibitors, other glucocorticosteroids and amphotericin B increase the risk of hypokalemia, sodium-containing drugs - edema and increased blood pressure.

Non-steroidal anti-inflammatory drugs and ethanol increase the risk of ulceration of the gastrointestinal mucosa, bleeding,in combination with non-steroidal anti-inflammatory drugs for the treatment of arthritis, it is possible to reduce the dose of GCS due to the summation of the therapeutic effect.

Indomethacin, displacing dexamethasone from association with albumin, increases the risk of developing its side effects.

Amphotericin B and carbonic anhydrase inhibitors increase the risk of osteoporosis.

The therapeutic effect of GCS decreases under the influence of phenytoin, barbiturates, ephedrine, theophylline, rifampicin and other inducers of "hepatic" microsomal enzymes (an increase in metabolic rate).

Mitotane and other inhibitors of the function of the adrenal cortex may necessitate an increase in the dose of GCS.

The clearance of GCS rises against the background of thyroid hormones.

Immunosuppressants increase the risk of infection and lymphoma or other lymphoproliferative disorders associated with the Epstein-Barr virus.

Estrogens (including oral estrogen-containing contraceptives) reduce the clearance of GCS, prolong the half-life and their therapeutic and toxic effects.

The emergence of hirsutism and acne is facilitated by the simultaneous use of other steroid hormone drugs - androgens, estrogens, anabolic steroids, oral contraceptives.

Tricyclic antidepressants can increase the severity of depression caused by dexamethasone (not shown for the therapy of these side effects).

The risk of developing cataracts increases with the use of other SCS, antipsychotic drugs (neuroleptics), carbutamide and azathioprine.

Simultaneous appointment with m-holinoblokatorami (including antihistamines, tricyclic antidepressants), nitrates contributes to the development of increased intraocular pressure.

With simultaneous use with fluoroquinolones, the risk of tendonitis (predominantly Achilles tendon) increases in elderly patients and in patients with tendon diseases.

Antimalarial drugs (chloroquine, hydroxychloroquine, mefloquine) in combination with dexamethasone may increase the risk of myopathy, cardiomyopathy.

Angiotensin converting enzyme inhibitors with concomitant administration with dexamethasone may alter the composition of peripheral blood.

Special instructions:

Assigning dexamethasone with intercurrent infections, septic states and tuberculosis,it is necessary to simultaneously treat specific antibacterial therapy with the drug in patients with latent tuberculosis, lymphadenitis after vaccination with BCG, poliomyelitis, acute and chronic bacterial, parasitic infections; specific therapy in patients with gastric and / or intestinal ulcer, osteoporosis.

With daily administration to 5 months of treatment, atrophy of the adrenal cortex develops.

Can mask some symptoms of infections; during treatment it is useless to carry out immunization.

With sudden abolition of SCS, especially in the case of previous use of high doses, there is a syndrome of "cancellation" of GCS (not due to hypocorticism): decreased appetite, nausea, blockage, generalized musculoskeletal pain, asthenia, and possibly the emergence and acute adrenal insufficiency arterial pressure, arrhythmia, sweating, weakness, oligoanuria, vomiting, abdominal pain, diarrhea, hallucinations, fainting, coma).

After the abolition, the relative adrenocortical cortex remains relatively insignificant for several months.If during this period there are stressful situations, appoint (according to indications) for the time of GCS, if necessary in combination with mineralocorticosteroids.

The dose of dexamethasone should be temporarily increased in case of stressful situations during therapy (surgery, trauma). Temporary increase in the dose of the drug in stressful situations is necessary both before and after stress.

Children during prolonged treatment need careful monitoring of the dynamics of growth and development. Children who were in contact with sick measles or chickenpox during the treatment period prophylactically prescribe specific immunoglobulins.

During treatment with dexamethasone (especially prolonged) it is necessary to observe the oculist, control blood pressure and water-electrolyte balance, as well as patterns of peripheral blood and glucose concentration in the blood.

In order to reduce side effects, it is possible to prescribe anabolic steroids, antacids, and also to increase the intake of potassium ions into the body (the intake of food rich in potassium and calcium, or the intake of potassium, calcium, and vitamin D preparations). Food should be rich in proteins, vitamins, containing a small amount of fats, carbohydrates and salt.

In children during the growth period, SCS should be used only in absolute indications and under the strictest supervision of the attending physician.

With the use of dexamethasone, there is a risk of developing severe anaphylactic reactions, bradycardia.

On the background of therapy with the drug, the risk of activation of strongyloidiasis is increased.

During therapy with the drug, careful monitoring of the condition of patients with CHF, uncontrolled hypertension, trauma and ulcerous lesions of the cornea, glaucoma is necessary.

May worsen myasthenia flow.

Against the background of the use of GCS, a change in the motility of spermatozoa is possible.

Taking the drug may mask the symptoms of "irritation of the peritoneum" in patients with perforation of the wall of the stomach or intestine.

The effect of the drug is enhanced in patients with cirrhosis of the liver.

It should be noted that in patients with hypothyroidism, the clearance of dexamethasone decreases, and in patients with thyrotoxicosis - increases.

In patients with diabetes mellitus, blood glucose concentrations should be monitored and if necessary, dosages of hypoglycemic drugs should be corrected.

Effect on the ability to drive transp. cf. and fur:

Given the possible side effects during drug therapy Dexamethasone, care must be taken when managing transport and working with mechanisms, engaging in other activities that require an increased concentration of attention and speed of psychomotor reactions.

Form release / dosage:

Tablets, 0.5 mg.

Packaging:

For 10, 14 tablets in a contour mesh box made of a polyvinylchloride film and aluminum foil.

For 5, 10 contiguous cell packs of 10 tablets or 4 contour packs of 14 tablets with instructions for use in a pack of cardboard.

Storage conditions:

In the dark place at a temperature of no higher than 25 C.

Keep out of the reach of children.

Shelf life:

4 years.

Do not use after the expiration date.

Terms of leave from pharmacies:On prescription

Registration number:LP-000882

Date of registration:18.10.2011 / 19.01.2017

Expiration Date:Unlimited

The owner of the registration certificate:UPDATE OF PFC, CJSC UPDATE OF PFC, CJSC Russia

Manufacturer: & nbsp

UPDATE, PFC CJSC Russia

Representation: & nbspUPDATE OF PFC, CJSCUPDATE OF PFC, CJSC

Information update date: & nbsp22.04.2017

Illustrated instructions

Instructions

Dexamethasone (Dexamethasone)